Modern scientific researches about interaction between TBI and PTSD are characterized by few amounts and contradiction of conclusions.

Twenty-eight persons with TBI were examined by means of questionnaires and structured clinical interviews. 17 patients were suffering from PTSD. We compared clinical features in patients with isolated TBI and group with both disorders.

Four groups of symptoms were analyzed–sleep, emotions, cognition and personality features. Disorders of sleep were presented with violation of REM cycle, nightmares, hyperexcitation, increase watchfulness during the sleep. Emotional disorders were expressed as lability without external irritations; an excessive emotional reaction is on small events, agitation, irritability, inadequacy of emotional reactions and apathy (loss of desire to think, to feel, and/or to operate). Cognitive disorders included deceleration of psychomotor reactions, difficulties of searching of words in communication, problems of switching of attention, rigidity, difficulties in planning, decision of multistage tasks, violation of operative memory, executive dysfunction. Features of personality disorders were loss of initiation and self-control, decline of spontaneity, surplus attention is to the details, inadequacy of self-appraisal, feeling of inferiority, an increase necessity is for control and lordship over other, aggression (socially inadequate behavior, episodes of anger).

Psychopathological features presented in patients with comorbidity of PTSD and TBI are not specific and can be within the framework of other psychogenic, exogenous, organic, posttraumatic or neurological disorders and diseases. PTSD can combine with other psychical and somatic disorders that caused chronological and pathogenetical comorbidity in patients with both states.

The authors have not supplied their declaration of competing interest.

Approximately 30–60% of the stroke survivors suffers from depression. This, together with the physical changes after stroke may lead to a decline in their quality of life (QOL). The aim of this paper was to analyse the incidence of post-stroke depression, associated risk factors and its influence on the QOL.

We carried out a prospective study on stroke patients during a period of 6months. We excluded patients with dysphasia and aphasia. For each patient, we collected socio-demographic characteristics as well as clinical and therapeutic data. We used the Hamilton Depression Scale to screen for anxiety and depression, the SF-36 scale to assess the quality of life and modified Rankin scale (mRS) to measure the degree of disability.

We included 155 men and 143 women with stroke, with mean age of 58.15 years. Out of 298 analysed patients, depression was present in 147 (49.3%). Associated risk factors were hypertension, female gender and severity of stroke (P < 0.05). The mean score of the SF-36 was 52.18. Impaired QOL was found in 221 (74.1%) and mRS > 3 was found in 169 (57.1%) of the patients. Impaired mental component of QOL significantly correlated with the presence of depression (P < 0.05) and anxiety (P < 0.05). The severe degree of disability had a significant negative impact on all areas of QOL.

Important effect after stroke is occurrence of depression which affects the QOL and functional outcome. All stroke patients should be evaluated for depression through regular interviews with them and their families or caregivers. Adequate antidepressant treatment should be given, in order to improve the QOL and physical rehabilitation.

The authors have not supplied their declaration of competing interest.

Extended brief interventions (EBIs) are effective in targeting alcohol misuse in the general population. However, little is known on the effects of EBI in adults with intellectual (also known as learning disabilities).

In this feasibility trial we compared EBI with usual care for alcohol misuse in adults with mild to moderate intellectual disability (ID).

The study took place in three community ID services in England. Participants aged 18–65 years with reported alcohol problems, a score > 8 on the alcohol use disorder identification test (AUDIT), and IQ < 70 (+/5% CI) were recruited and were randomly allocated to either EBI (5 weekly sessions and 1 follow-up at 8 weeks) and usual care or usual care alone. Research assessments took place at baseline, two and three months.

Thirty individuals were randomised (15 in each arm). In regard to harmful drinking, at baseline, all the participants exceeded the relevant threshold. At 8 weeks, the proportion of participants with harmful drinking decreased to 60% for both groups, at 12 weeks it was decreased by 66.7% and 46.7% for the intervention and the control group respectively. The unit cost for the delivery of EBI is £ 430.

Recruitment to this trial has been proven challenging as prevalence of alcohol misuse in the targeted population was lower than anticipated. EBI may provide an effective low intensity treatment for this population. Participants’ and carers’ feedback on their experience was overall positive.

The authors have not supplied their declaration of competing interest.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent difficulties with attention, increased impulsivity and hyperactivity. Comorbidity is often reported in adults with ADHD with a range of 60–100% of patients having at least one co-morbid condition.

The purpose of this study is to determine the prevalence of ADHD among university students and to investigate some co-occurring symptoms and disorders.

We aimed to raise awareness of adult ADHD and underscore its co-morbidity.

486 undergraduate students at Bezmialem Vakif university in Istanbul filled in the Adult ADHD Self-Report Scale (ASRS), Beck Anxiety Scale (Beck-A), Beck Depression Scale (Beck-D) and a purpose-designed structured socio-demographic form.

Our results revealed that 6% of participants reported significant ADHD symptoms using 1.5 standard deviation above mean on the ASRS. 67% of students with significant ADHD symptoms had a psychiatric history other than ADHD. History of depression, anxiety and sleep problems were significantly higher in this group (P < 0.05). They scored higher on Beck-A and Beck-D (P < 0.05). Students with significant ADHD symptoms reported more night eating, binge eating behaviours and more headache (P < 0.05). There was no statistically significant difference in the history of epilepsy, asthma, allergy and diabetes. Family history of psychiatric disorder particularly ADHD, depression and eating disorder were higher in the ADHD group (P < 0.05).

Our results demonstrate that ADHD is prevalent among university students with high co-morbidity. Hence people with ADHD need comprehensive and lifelong assessment and management of their symptoms and needs.

The authors have not supplied their declaration of competing interest.

To study frequency and time until death due to general causes in groups of patients with comorbid MD, and without them as well as interrelationship of these indicators with comorbid MD and therapy with antidepressants.

Inpatients with chronic CAD (n = 333) under conservative therapy were investigated (31% females (n = 103), 69% males (n = 230), mean age 61.8 ± 9.8 years). Team of cardiologists and psychiatrists followed up patients for 7 years (2008–2014). Survival frequency was evaluated by method of life tables.

Among patients under conservative therapy of CAD the death frequency due to general causes did not differ significantly in presence (n = 80) and absence of MD (n = 253) and was 18.8% and 16.6%, respectively. Correlation of deaths with hypomanic and mixed episodes was revealed (rs = 0.3). The groups differed according to function of immediate risks: patients with MD were at high risk of death during the year after detection of affective symptoms, and in group without MD it increased over the time of observation (Р = 0.0000).

Duration of antidepressant therapy was 5.5 ± 0.5 months. Among patients receiving antidepressants (n = 20), during therapy and after one month after discontinuation there were not deaths. Difference of function of immediate risks in these subgroups was not significant (Р = 0.09).

Patients with affective disorders and chronic CAD under conservative therapy are at high risk of death within affective episode and therapy with antidepressants did not influence change of risk of death.

The authors have not supplied their declaration of competing interest.

Smoking is the leading preventable cause of morbidity and mortality in the world and the leading cause of death in alcoholics. The prevalence of smoking among alcohol addicts is very high as among homeless people. Both groups have a higher risk of smoking-related illnesses. It seems that quitting smoking increases the rate of alcohol abstinence. It is therefore crucial to perform treatment of tobacco dependence among this population.

Population: homeless alcoholic patients in treatment at the Association Rauxa with dependence criteria DSM-IV-TR and DSM-V, male, over 18 years. Anamnesis, examination, analysis, chest X-ray, addictive history is practiced. Patients are encouraged to start smoking treatment. Once the decision is made.

Tests: motivation, Fagerstrom, fasting weight; weekly and random monitoring of CO in exhaled air. Treatment with decreasing nicotine patches. Weekly smoking therapies. Withdrawal symptoms and relapse, timely or complete, if it occurs, are evaluated. Treatment ends in one year without relapse.

n = 237(2006:n = 19; 2007:n = 26; 2008:n = 24; 2009:n = 33; 2010:n = 31; 2011:n = 25; 2012:n = 33; 2013:n = 25 y 2014:n = 21)

Get high on2006:10/19 (53%); 2007:14/26(54%); 2008:13/24 (54%); 2009:9/33 (27%); 2010:6/31 (19%); 2011:2/25 (8%); 2012:8/33(24%); 2013:9/25 (36%); 2014:11/21 (52%). In 9 years, 82/237 (35%) finishes treatment without relapse.

A percentage of 35% is obtained discharge. Different parameters-relapse are correlated to see predictors of relapse.

No correlation is found statistically significant.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Gastroesophageal reflux disease (GERD) is more prevalent among patients with major depressive disorder (MDD) than in general population, and vice versa. Bidirectional association of GERD and MDD is well documented. Although protective effect for gastric symptoms has been indicated for several antidepressants like trazodone, citalopram, fluoxetine, mirtazapine or fluvoxamine, these findings are sometimes contradictory. Similar may be claimed for antidepressive effect of some proton pump inhibitors. We decided to examine the association of GERD with the long-term efficacy of MDD treatment.

To examine the association of GERD and efficacy of MDD treatment.

This nested cross-sectional study was done during 2016 at Psychiatric hospital Sveti Ivan, Zagreb, Croatia on the sample of 1008 psychiatric patients. Key outcome was the number of psychiatric rehospitalizations since the first diagnosis of MDD. Predictor was patient-self-declared diagnosis of GERD. Covariates controlled by multivariate analysis of covariance were sex, age, duration of MDD in years, education, marital status, number of household members, work status, clinical global impression scale–severity of MDD at diagnosis, treatment with tricyclic antidepressants (TCA), selective serotonin reuptake inhbitors (SSRI), serotonin-norephinephrine reuptake inhibitors (SNRI), noradrenergic and specific serotonergic (NaSSA) and antipsychotics.

MDD patients with GERD had significantly larger number of psychiatric rehospitalizations (mean = 5.4 (SD 6.82)) than MDD patients with no GERD (mean = 3.1 (SD 4.45)). After adjustment for all covariates, GERD significantly moderated the efficacy of treatment of MDD (P = 0.048; η2 = 0.05) (Figure 1).

To treat MDD effectively we should treat GERD as well.

The authors have not supplied their declaration of competing interest.

Personality disorder (PD) with an associated diagnostic of major depressive disorder (MDD) is a common occurrence, being considered a factor of treatment resistant depression. In this study, we compare two groups of patients’ one group having Major Depressive Episode (MDD) and the other with MDD and PD as comorbidity.

This is an observational study of all patients admitted with diagnosis of MDD during one month period in an acute psychiatric hospital. Data collection is made using patients files. During one month period a total number of 105 MDD cases were recorded (group A-75 cases with MDD and group B-30 patients with PD and MDD). The diagnosis was recorded in files by a specialist psychiatrist. Data is analyzed using SPSS v.20.

A significant difference is found when comparing age groups, mean age for group A being 60 years and for group B 35 years (P = 0.05). Regarding suicide attempts a higher prevalence is found in Group B (Group A 6.7%, Group B 20%) although with statistical relevance (P = 0.04). Study limitation: small sample size of group B does not allow analysis on different type of personality disorders, length of hospitalisation could be biased by the requirements of assurance company.

The risk of admission is higher at younger age in patients with MDD associated with PD then in MDD alone. The risk of suicide attempts is significantly higher in group of MDD associated with PD.

The authors have not supplied their declaration of competing interest.

Serious mental illness (SMI) is associated with poorer cancer outcomes. Reasons for such inequalities are unclear; those with this comorbidity receive fewer specialist interventions and die earlier than the general population. Further exploratory work is required.

Exploring the experience of SMI and cancer from the perspective of those affected by this comorbidity and those caring for them professionally or informally.

Semi-structured interviews were conducted with ‘key patients’ living with SMI who had received a cancer diagnosis (n = 7), significant others who had supported key patients (n = 4) and healthcare professionals who had worked with at least one KP (n = 17). A panel of patients and professionals ratified interview guides. Interviews were analysed thematically.

Mental health professionals were more confident in their knowledge of the needs of this population than oncology professionals, but were challenged by working with patients with major physical health needs. Key patients’ mental health appeared to remain stable after cancer diagnosis, and they expressed altruism towards others with comorbid cancer and SMI. Significant others and healthcare professionals were more likely to critique systemic aspects of care than were key patients.

Professionals feel challenged when working outside of their usual job role. Training needs include mental illness awareness in an oncology setting. Improved coordination and communication is required, encompassing significant others as well as professional groups. SMI may protect against the psychological impact of cancer. Key patients were keen to provide advice and support to others in similar situations. Further research is needed into these areas.

The authors have not supplied their declaration of competing interest.

Venous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.

There has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.

VTE and physical health assessment data was collected by checking electronic admission summaries from three acute psychiatric in-patient wards on a random date in 2016. The local pathway for the management of physical health and wellbeing states that the VTE assessment and Physical Health Assessment should be completed within 6 hours of admission. NICE guidelines also state that all patients should be assessed on admission, with a standard of 100%.

60% of patients had a VTE assessment and 54% of patients had a physical health assessment done within 6 hours of admission.

This audit shows that the necessary standards are not met. Importance of these assessments has been communicated during induction programmes for all staff.

The authors have not supplied their declaration of competing interest.

Using Pubmed and PsychInfo, we conducted a narrative review of the literature on cannabis and psychiatric comorbidity using the keywords cannabis, psychosis, mood, depression, mania, bipolar, and anxiety.

There is substantial evidence of an association between cannabis use and psychosis. A few reports suggest an association with bipolar disorder while the association with depression and anxiety disorders is mixed.

The present review confirms earlier findings of an association between cannabis use and a lower age at onset. Data shows that cannabis use, beginning in the adolescence and with a frequency higher than once a week, correlates with the development in adult age of affective symptoms and/or disorder, mainly in bipolar disorder, with a moderate relation with Depressive spectrum. Even more, some authors hypothesize that cannabis may play a role in the development of the disorder, that to say, affective disorder would not appear in the absence of cannabis use. The current findings suggest that recent cannabis use is associated with a more severe course of illness in the early phase of BD I.

Recent cannabis use was also associated with more lifetime suicide attempts.

The authors have not supplied their declaration of competing interest.

There exists a high prevalence of SUD among patients suffering ADHD and the consequences of this comorbidity are that AHDH and SUD may exacerbate the outcome of SUD and vice versa. The presence of both disorders increases the risk of chronicity and the level and/or the number of symptoms.

The main objective is to evaluate how the introduction of treatment correlates with a better control of symptoms.

We select a group of patients with both diagnosis treated in a Mental Health Day Center in Pamplona, Spain.

We employ several scales to evaluate the sample: SCL-90, SF-36, Weiss Scale and a Scale of Satisfaction, in three times: at the beginning, one month and three months. We employ urinalysis to detect level and number of substances.

The sample is comprised by 12 patients, main age of 42.6 years. 8 patients are cocaine addicts. The majority received Atomoxetine (main dosage 36.0 mg)

Our data shows an important decrease in the score of Neurotics groups of symptoms and Hostility. We observe a decrease in score of items correlated with physic health and an increase in emotional aspects of daily life.

Eight patients gets abstinence and the punctuation of craving decrease from 21 to 5.2.

The level of satisfaction with treatment was very high.

The psychopharmacological treatment of patients diagnosed of ADHD with comorbid SUD implies a great improvement in the symptomatology and quality of life of the patients, with a low level of craving.

The authors have not supplied their declaration of competing interest.

Methanol poisoning is uncommon but potentially lethal. The way of poisoning is usually oral. However, in a small number of cases, inhalated methanol poisoning was described. Most of these occurred among patients suffering a disorder by use of this substance. This type of poisoning has an insidious presentation, that complicates its diagnosis. This poisoning may be lethal. It may produce a chronic and severe affectation of the central nervous system in those who survive to the poisoning. After diagnosis, it is compulsory to act quickly, and it often requires advanced vital support and hemodialysis.

Educate the Mental Health professionals about a type of disorder by consumption increasingly more frequent in some cities across Europe. This is a high fatality related poisoning that emergency and general psychiatrists should know as it is increasingly common in Europe.

We present the case of a 20-year-old patient, treated at the emergency department of our hospital in context of metanol inhalation. The patient regularly attended to our Dual Pathology outpatient unit due to a severe inhalant use disorder. Several stays at the intensive care unit had been recorded and he already presented with severe optic nerve affectation.

In recent years there has been an increase in inhalant abuse in Europe, which is still underestimated by our poor knowledge about its potential toxicity.

Inhalated methanol poisoning occurs with a typical presentation, and may appear after suicide trial or overdose. Mental health professional should become aware of its potential lethality to approach properly to these patients.

The authors have not supplied their declaration of competing interest.

Several studies point to the importance that the complex formed by GABA and the benzodiazepine receptor play for cerebral dopaminergic transmission and, hence, to the pathophysiology of psychotic symptoms. The decrease in GABA neuratransmisión or the hypofunction of the system in the hippocampus, cortex and other limbic prefrontal or subcortical regions has consequences as emotional dysregulation, cognitive impairment and development of positive psychotic symptoms.

We intended to show an additional practical example to the limited literature available based on a case linking the emergence of psychotic symptoms due to acute benzodiazepine withdrawal.

We present the case of a 21 year old man who was sent to the emergency room of our hospital after an episode of aggressiveness on the street. The patient showed a psychotic schizophrenic syndrome with significant emotional and behavioural impact with aggressive and bizarre movements. In parallel, restlessness, sweating, tremor, increased blood pressure and tachycardia were observed. Symptoms had started abruptly two hours earlier. The patient companion explained that he usually took Alprazolam at an of over 40 mg per day. He had decided to give up this consumption abruptly four days earlier.

GABAergic deficits cause the imbalance between excitatory and inhibitory neurotransmission that may relate the pathophysiology of psychotic symptoms. The dysfunction of the GABAergic cortical interneurons could affect to the modulating response from the association cortex, which, could also relate with the appearance of these symptoms.

This case could relate a decrease in GABAergic transmission with the appearance of psychotic symptoms.

The authors have not supplied their declaration of competing interest.

Psychiatric disorders, particularly mood disorders, have a profound effect on the use of and adherence to highly active antiretroviral therapy (HAART) among patients with human immunodeficiency virus (HIV) infection.

HIV infection and mood disorders have features in common, and each is a significant risk factor for the other.

The objective is to highlight the clinicians on the importance of screening and treating affective disorders among patients with HIV infection.

Two cases of HIV infected patients with comorbid mood disorder and torpid evolutions by poor adherence to treatment are reported.

A brief literature review on this subject is done.

Major depression has been shown to alter the function of killer lymphocytes in HIV-infected patients and may be associated with the progression of HIV disease.

HIV-positive patients with mental disorders are less likely to receive and adherence to antiretroviral therapy.

First case-report: a man 52 years old, HIV-positive since 1985 with a comorbid bipolar disorder, with recurrent depressions and poor adherence to both treatment with a rapidly exitus laetalis.

Second case-report: man 45 years old, HIV-positive since 1992 with a comorbid depressive disorder, non-adhered to both therapy and HIV-associated dementia.

Depressive disorders are common in HIV infection. Antiretroviral regimens for HIV-infected patients require strict adherence. Untreated depression has been associated with medication nonadherence. Understanding the contribution of depression and its subsequent treatment on antiretroviral therapy adherence might direct clinicians toward earlier identification and more aggressive treatment among this population.

The authors have not supplied their declaration of competing interest.